Transcript Axis Determination on an EKG

Axis Determination on
an EKG
by
Don Hudson, D.O., FACEP/ACOEP
I prefer to keep it real
simple !!
• There are lot of nuances that will not
be picked up this way but that is in
the area for the Cardiologist.
• First do the EKG
• Lay it down and put your thumbs over
leads I and aVf.
• Point them in the same direction as
the QRS.
Place your thumb over leads I & aVf
pointing in the direction of the QRS
NORMAL
LAD
RAD
NO MANS LAND
Why do you care about
the Axis
• Normal is simply obvious
• Left Axis Deviation indicated that ½ of
the two left Bundles of HIS is not working
either the anterior or posterior branch.
In this simple format we don’t care which
one, anterior or posterior.
• Right Axis Deviation indicates a probable
Rt. Ventricle Hypertrophy
No Man’s Land Axis
• This problem with this lead is it may
represent either an extreme RAD or an
extreme LAD.
• The point is in the simplified version you
recognize it as abnormal and it may be an
indication of either a left hemiblock or
right ventricular hypertrophy.
• Either finding requires further testing and
evaluation of the patient.
Right Axis Deviation
• We have already considered that this
finding indicates right ventricle
hypertrophy
• Since this side of the pump normally pumps
to the lung the consideration of a disease
process causing the vessels in the lung to
be non-complient and therefore more
difficult for the heart to pump blood into.
What is most important
• These are all important factors.
• You will most often see LAD in the general
ER patient.
• The other abnormality you will need to add
to the axis determination is Bundle Branch
Blocks
• These will be gone over in another section